559
THE EYES IN HOT CLIMATES.
fractured clavicle occurred, but this isnot real dentistrv. The new decree stiffens the statute of evidence of repair in a malignant growth. P,tients March 31st, 1912, since it not only requires all dentists who have suffered a pathological fracture of the to be previously qualified in medicine and surgery, but femur secondary to breast cancer have even been enjoins upon all future medical practitioners the The undergoing of a practical test in dentistry and known to get union and walk for a time. a of is that the mechanics to enable them to practise the art of portion only simplest explanation thickness of the bone was destroyed by the growth. medicine. It is not that the medical graduates of The remaining unaffected area, after fracture, was the universities, to which the new statute allows able to throw out so much callus as to form a support freedom in regulating their special studies, will all be of weight bearing capacity. It has been frequently finished dentists, but they will at least know enough observed that bone metastases occur in cases where the to guide them in investigating each case and adopting
original growth is quite small, so it practical imp rtance to be able to
would be of great ascertain whether the bones are affected or not when the patient seeks surgical aid. According to A. Piney! certain characteristic blood changes occur when the growth invades the bone-marrow, by which this invasion can be recognised. Whilst this statement is true in some cases, it does not seem to be so invariably ; the characteristic blood picture was absent in the case under discussion. It is, however, important on occasion to make the blood examination, for positive evidence might show that operative interference would be useless. ____
THE
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proper treatment, especially in rural districts where there is no expert dentist. In Italy the future medical practitioner will have a knowledge of the fundamentals of dental science, as he has of ophthalmology and dermatology. For dentists in the future-i.e., medical specialists in dentistry and prosthesis-the general university reform actuated by Gentile efficiently provides in the same way as it does for all other specialists. This measure that no one can arrogate to himself the title " in any branch of medicine without of " specialist having acquired the relative diploma granted by each university. Anyone who does not conform to this rule will be suspended from practising, so that in the near future the public will be able to distinguish the true from the false specialist. In fact, this same reform allows each university to establish special post-graduate schools in any subject, equipped for granting, after examination, specialists’ diplomas. As far as dentistry is concerned, there already exist in Italy the three dental schools of Milan, Bologna, and Florence with a yearly curriculum; and now, in order to ma,rch with the times, these have profited by the present didactic legislation and have biennial courses, while other schools will of necessity spring up. Italy will thus be the first among progressive nations to require all medical practitioners to know at least the principles of dentistry and dental mechanics and to insist that all who practise other medico-chirurgical specialties shall, after having obtained their degree, pass a special examination which will be proof of a real knowledge of the specialty they intend to
enjoins
PRESENT POSITION OF THE DENTAL PROFESSION IN ITALY. WE havereceived from Dr. F. Montuschi, dental surgeon to the Italian Hospital, a report on the recent legislation in Italy to regulate the practice of dentistry. ’The Royal Decree of Oct. 16th, 1924, made the possession of a degree in medicine and surgery compulsory for the practice of dentistry. This compulsion dates back 34 years from the Boselli decree, but subsequently all those who had practised dentistry by virtue of minor diplomas granted by various universities continued to do so and, as is the case now in England, many who had practised without a diploma were allowed to continue after an examinaThe Boselli decree did not tion in the subject. become law until 1912 with the concurrence of both branches of the legislature. There was, however, in Italy an absence of good schools for the teaching of practise. dentistry and such medical men as wished to practise it conscientiously were obliged to go abroad. Many THE EYES IN HOT CLIMATES. of them came to our Royal Dental Hospital until IN a paper on Ophthalmology in Egypt, read at a the foundation of three dental institutes at Milan, recent meeting of the Section of Tropical Medicine of Bologna, and Florence, each of which has a curricu- the Royal Society of Medicine, Mr. A. F. MacCallan, lum of one year’s duration. In Rome a small but influential group continued to ask for a doctorate in at one time Director of the Egyptian Government Ophthalmic Hospitals, gave some valuable instrucdentistry independent of medicine and surgery, tion on the care of the eyes in hot climates. somewhat after the type of the American D.D.S.1 fatigue, ill-health, and worry bring out latent They wanted the medical student after his fourth While defects in the eyes in any country, a hot climate year to relinquish his studies and join the school of fatigue than a temperate one, and this dentistry and dental mechanics which was to be causes greater established in Rome, and after a curriculum of two fatigue, lie pointed out, may lead to fatigue-indigestion years to pass an examination which would confer on with resulting physical depression. Worry, whether him a doctorate in dentistry and dental prosthesis. of official or of private origin, similarly may cause These ideas found sympathy from the Minister of ill-health. Under these conditons he found that Public Instruction in Signor Mussolini’s Cabinet, who, trifling errors of refraction, or slight degrees of owing to the full powers conceded by Parliament, heterophoria, exerted effects quite out of proportion secured at the end of 1923 the approval of the Council to their actual severity, and he emphasised the of Ministers for a decree establishing a national school importance of careful correction of these errors, of dentistry and dental mechanics in Rome; this generally under a cycloplegic such as homatropine. In meant the institution of a degree in these subjects at a highly sensitive patient, whose nerves were conthe end of the prescribed course of study and the stantly being jarred by physical or mental discompassing of a special examination. This decree forts, the correction of a very small degree of aroused violent opposition, as medical opinion had astigmatism might make all the difference between pronounced in favour of a compulsory degree in medi- happiness and misery. In a country such as Egypt, cine and surgery for dentists. Augosto Murri wrote the healthy emmetropic eye of the European becomes expressing his views as to the indivisibility of dentistry painfully affected by the sun’s glare in the summer and general medicine and advocating that the former when motoring or riding along dusty roads or over must be considered as belonging to the same category the desert. It is the heat rays from the red end of To prevent the as other medical specialties, and a few months later the spectrum which cause this. the Minister who had approved of the decree was effects of glare, Mr. MacCallan advises the wearing of replaced by Senator Casati; then the Mussolini protective goggles of Crookes B or B 2 material; but Cabinet rescinded the decree and substituted a new if discomfort is complained of the refraction of the one which re-affirmed the principle of a compulsory patient should be verified under a cycloplegic. degree in medicine and surgery for the practice of There are, he states, other varieties of protective glasses, which theoretically are more absorbent of 1 Brit. Jour. Surg., 1922, x., 235. the heat rays than Crookes glasses, such as peacock ____
560
SURGICAL TREATMENT CENTRES.—THE ANATOMY OF I’WINS.
blue, Fieuzal, and amber, but in his own expcrÏ< nee County Council consider it to be one of the most of a large number of cases he found that ordinary glass satisfactory services in the county. A good number in which was included, if necessary, a very small of children from the London hospitals are treated ametropic correction, was all that was required. in the Surrey posts, some of these attending their Sun, dust, and wind might also cause pin guecula and own surgeons at the London hospitals. The County pterygium. In dust,y seasons it is most advisable of London branch established similar clinics in 1919 to wash from the eyelids the dust which collects there and at one time there were 13 such treatment centres and which may contain septic material. This should for disabled ex-Service men in various parts of be done three times a day. In many cases he found London. With the decrease in the number of men this simple precaution sufficient to prevent constantly requiring treatment certain of these centres have been closed and only five remained at the end of 1924. recurring attacks of conjunctivitis. In February, 1922, a civilian clinic was opened in Kensington to meet the needs of those who are unable to afford the full fees obtaining for massage SURGICAL’ TREATMENT CENTRES. and electrical treatment. A maximum fee of 5s. per THE medical profession and the lay public are treatment is charged, the fees graduating down to alike apt to associate the Ministry of Pensions with Is. 3d. per treatment. Towards the end of 1924 a medical boards and claims and awards rather than similar clinic was opened in Hackney. From this brief with any idea of treatment of war disabilities. The it will be seen that the treatment aspect of summary article which we publish in another column by Dr. war disabilities is receiving the consideration it C. V. Mackay and Mr. D. D. Pinnock on the treatment warrants from both voluntary and official bodies, of war injuries at special surgical clinics, dealing and the extension of the Red Cross Society’s activities with this lesser known but very important side of to civilian forms an important and interesting patients the Ministry’s activities, shows that valuable work is still being done up and down the country in the development. treatment of those disabling effects of the war which THE ANATOMY OF TWINS. in so many cases continued for a long time afterr TwiN bodies of the uniovular type do not often the crippled men left the services. The organisation1 come to the anatomist for examination. I3ence not and work of these special clinics are clearly set out. much is known with certainty or conclusive definite It will be seen that the whole scheme is closely linked.ness about the relations existing between the twins up with the surgical hospitals of the Ministry ofof this form, and the views advanced from time to Pensions and with the centres for the provision of" time about the cause of twinning are little more than surgical appliances and artificial limbs. Existing assumptions adopted to fill the void of ignorance on facilities at civil hospitals have also been utilised,, the The theory of polyspermy as a cause and it will be seen that every encouragement is givenis ansubject. of such assumption ; it is probably example to pensioners to make use of the treatment thus unsound and untenable from the nuclear and quite offered by the payment of travelling expenses and point of view, and it can be pointed out of allowances for time lost from work on account’ in animals in which polyspermy normally or that, of treatment. Apart from the clinics at civil and occurs, the additional spermatozoa are Ministry hospitals, surgical treatment centres havenon-ettective to all appearance, while in a case like been established in various parts of the country at’ that of the armadillo, in which normally more than the following places :one embryo is formed from a single ovum, there does Northern Region.-B;shop Auckland, Bradford, Carlisle, not seem to be polyspermy. All that can be said Hull, Stockton, Sunderland. with certainty is that the uniovular twin is an endNorth-Western Region.-Birkenhead, Manchester. of the process of dichotomy affecting the Midlands Region.-Birmingham, Coventry, Nottingham. product contents of the developing ovum, and the embryonic South-Western Region.-Bnstol, Exeter. London Region.-Brighton, Westminster, Camberwell, cause of its occurrence will be known when the explanation and meaning of dichotomy is underTooting, Portsmouth, Reading, Southampton. Scotland Region.-Aberdeen, Dundee, Edinburgh, Glasgow, stood. The result of dichotomy may be incomplete or complete division, and, in its axial form, ranges Kirkcaldy, Stirling. Wales Region.-Bridgend, Pontypridd, Wrexham. from the parasitic foetus and other monstrosities, The majority of these clinics deal also with the through the partially attached individuals to the supply of surgical boots and appliances. In addition completely separated twins. In this last case the to these centres, the British Red Cross Society has embryonic division may stop at this point, leaving also established " Curative Posts," for the benefit the amnion undivided, or may even involve this, so of ex-Servi e men, which are recogni ed by the that each individual possesses his or her own amnion. Ministry of Pensions. For example, in the county ofI It is theoretically conceivable that the dichotomous Surrey alone five were established by the county process, beginning at the earliest possible moment,. lead to complete division of the whole ovum, branch of the British Red Cross in 1919. The posts that each foetus would have its own chorion and are fully equipped with electrical apparatus, and in some cases X ray photographs can be taken. TheIplacenta; but the occurrence of such a condition has voluntary staff consists of an officer in charge, an never suggested itself to any observer, and a single almoner, registrar and treasurer. and V.A.D. helpers. chorion and placenta may thus be considered a The professional staff consists of a medical officer, proper accompaniment of uniovular twins. This, in one or more trained nurses, and a varying number fact, seems to be the most valuable criterion, in in deciding on the nature of twin births.of masseurs and masseuses according to the of cases on the books. Since the diminution in the I Those of opposite sex are not uniovular ; when of number of ex-8ervice patients the1 osts have been the same sex they may or may not be so, but when used for civilians, to the great benefit of the inhabi- they are enclosed in a common chorion, or-the tants of the various towns and villages concerned. same thing-have a common placenta, they are The payments from civilian patients are supposed uniovular. When such details as these are lacking to vary from 2s. 6d. to 10s. 6d., the latter for several in the birth history, it is not possible to give more treatments combined, but unfortunately all patients than the negative pronouncement that twins of are not able to afford even the minimum charge, and different sex are not uniovular. The subject of in these cases various expedients have to be resorted twins is always fascinating, and Prof. G. R. Murray, to ; under certain conditions the funds of the branch in a presidential address published in this issue of are used to supplement the payments. Two of the THE LANCET, has ranged far afield and gathered posts, Woking and Kingston, have also opened many little-known items of information on the orthopaedic clinics for children under the care of an subject. Prof. Murray refers to one matter, the orthopaedic s rgeon from a London hospital who makes occurrence of situs inversus in certain individuals,. periodical visits. These are said to be a great success, which, in the past, has perhaps had more value and the medical officer of health reports that the Surrey ttrlh1lt(’(! o it than is .justifiable. It has been ’
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